Abstract
January 2020 was proclaimed National Slavery and Human Trafficking Prevention Month by the U.S. government. This year marks the 20th anniversary of when the United States took what was defined as “decisive steps in the global fight against human trafficking” (U.S. Department of Health and Human Services, 2020). This included enactment of the Trafficking Victims Protection Act of 2000 (Polaris, 2020) and establishment of the Palermo Protocol, a United Nations protocol to address trafficking transnationally, particularly in women and children (United Nations Human Rights, 2000). These decisive steps were defined as establishing a framework of prevention, identification, and prosecution aimed at human trafficking. In spite of these efforts, the problem of human trafficking in the United States and the world continues to be a significant public health problem. Why have considerable efforts at intervention seemed largely unsuccessful in preventing and targeting this problem? What can psychiatric nurses do to increase their diligence, identify the plan of intervention if they see trafficking, and intervene at a community level to address this significant issue?
The negative health consequences of human trafficking are unquestioned. Defined as the illegal trade of human beings for sexual exploitation and/or forced labor, resulting in profits for traffickers, trafficking is a violation of human rights and considered a form of slavery. It can include sex trafficking, forced labor, bonded labor, and recruitment of child soldiers (Murray & Smith, 2019; United Nations Office on Drugs and Crime, 2012). The majority of individuals experiencing human trafficking in the United States are women or girls (United Nations Office on Drugs and Crime, 2012). How can psychiatric nurses identify these individuals in their care and how can we facilitate treatment?
In reality, very few individuals self-identify that they are victims of trafficking or have this in their history. This is likely related to the shame and embarrassment experienced by victims, the threat of harm if this information is revealed, and concerns about the biases of health care professionals who might blame them (Cunningham & Cromer, 2016). Research conducted by Long and Dowdell (2018) identified the misperceptions of trafficking, specifically by emergency room nurses. Lack of formal screening; misperceptions of victims as predominantly young, female, and foreign born; sad and grieving; or prostitutes were all misperceptions identified by these researchers. Lack of assessment and limited knowledge about resources for human trafficking victims pointed to the need for more formal assessment tools and an education process for emergency room nurses, focusing on identification and intervention (Long & Dowdell, 2018).
Health care providers might see warning signs such as the controlling presence of another person during a health care interaction, the person’s inability to verify their address, lack of control of finances, lack of clarify about their living situation and safety, and signs of physical trauma (Murray & Smith, 2019). If the individual is an adult, they must provide consent to the health care provider before legal authorities can be contacted regarding suspicions (Richards, 2014). If the person does not consent, they can be given the National Human Trafficking Hotline number.
If the individual is a minor, health care professionals are mandated to contact the welfare or child guidance agency in their community and file a formal suspected abuse report. They should remain with the youth as they could be in imminent danger and should not leave the treatment setting until taken to safety. Afterwards, careful follow-up, documentation, and use of the treatment team as support for the caregiver is imperative. It is stressful to identify an individual who is being trafficked, especially if an adult does not welcome assistance or intervention.
The National Human Trafficking Resource Center (2016) offers a comprehensive framework for the development of a human trafficking protocol in health care settings. They identify the warning signs and ways this could be discussed with the patient. Importantly, they give resources that can be useful to the health care provider around next steps in assessment or treatment, including a flowchart of assessment and intervention. Any nurse can use this information if they suspect a patient is the victim of human trafficking, in any form. Resources and referral information can be accessed at www.traffickingresourcecenter.org and at 1-888-373-7888 (24/7).
The U.S. Public Health Service has identified research initiatives prioritized for human trafficking victims. These include clearly identifying the prevalence and incidence, the cost burden, risk and protective factors, and screening response and prevention strategies (Rothman et al., 2017). There is a need for a normed screening tool that addresses specific population issues that are related to the type of health care setting where the patient is seen.
Human trafficking is a serious public health problem that is largely unacknowledged in health care settings. This editorial has only superficially identified the complex issues that contribute to this. Psychiatric nurses and their colleagues in primary care are in a key position to identify these victims and provide the assessment and treatment required to move beyond the enslavement that characterizes trafficking. First, however, it has to be identified and acknowledged.